Pulmonary tuberculosis in childhood: clinical features, treatment side effects and factors associated with radiologic improvement
Background: Tuberculosis (TB) is a common public health problem and early diagnosis and treatment is important. Aim of the study: The aim was to evaluate complaints and radiological features, drug side effects, changes in radiological findings after treatment, and to evaluate the factors affecting this change in patients with pulmonary TB. Material and methods: One hundred patients with pulmonary TB were evaluated, and the following data recorded: age, gender, contact with TB patient, complaints, physical examination, tuberculin skin test, acid resistant bacillus, polymerase chain reaction and culture results, posteroanterior/lateral chest radiographs and thorax computed tomography findings at presentation and after treatment, treatment duration, and side effects. Treatment adherence and follow-up data were evaluated, and radiological findings before and after treatment were compared. In predicting radiological improvement, the effects of age, sex, duration of complaints, living in in rural/urban areas, treatment duration, treatment adherence, follow-up, and presence of cavitation were examined. Results: Mean age was 6.0 ± 4.2 years. 66 of the patients had contact history with TB patients. The most common complaint was cough, whilst infiltration and/or mediastinal lymphadenopathy were the most common findings in radiological examination at presentation. 84 patients were scheduled a treatment program for 6 months. Improvement in radiological findings were significantly better in patients who adhered to medication and follow-up protocols. Age, sex, complaint duration, living in rural/urban areas, treatment duration and presence of cavitation were not significantly associated with radiological improvement. Conclusions: Pulmonary TB should be considered in patients presenting with cough, even if their physical examination and chest radiographs are normal. Adherence to anti-tuberculosis treatment and follow-up were the most important factors in radiological improvement.
- 1. World Health Organization. Global tuberculosis report. Geneva: World Health Organization [online] 2017 [cit. 27.11.2017]. Available from URL: http://apps.who.int/iris/bitstream/10665/259366/1/9789241565516.
- 2. Seddon JA, Shingadia D. Epidemiology and disease burden of tuberculosis in children: a global perspective. Infect Drug Resist 2014; 7: 153–165.
- 3. World Health Organization. WHO guidelines on tuberculosis infection prevention and control, 2019 update. Geneva: World Health Organization; 2019.
- 4. Kara F, ed. Tüberküloz tanı ve tedavi rehberi. 2. Baskı. Ankara: T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü; 2019. (In Turkish).
- 5. Nahid P, Dorman SE, Alipanah N, Barry PM, Brozek JL, Cattamanchi A, et al. Official American thoracic society/centers for disease control and prevention/infectious diseases society of America clinical practice guidelines: treatment of drug-susceptible tuberculosis. Clinical Infectious Diseases 2016; 63(7): e147–e195.
- 6. Toma P, Lancella L, Menchini L, Lombardi R, Secinaro A, Villani A. Radiological patterns of childhood thoracic tuberculosis in a developed country: a single institution’s experience on 217/255 cases. Radiol Med 2017; 122(1): 22–34.
- 7. Tanır G. Tüberkülozlu çocuk hastanın antitüberküloz tedaviye uyumu ve tedavi sırasında izlemi. In: Özçelik U, Kocabaş E, Ersu R, Gürkan F, ed. Çocukluk Çağında Tüberküloz. Istanbul: Toraks Kitapları; 2017: 91–98. (In Turkish).
- 8. Chheng P, Nsereko M, Malone LL, Okware B, Zalwango S, Joloba M, et al. Tuberculosis case finding in first-degree relative contacts not living with index tuberculosis cases in Kampala, Uganda. Clin Epidemiol 2015; 7: 411–419.
- 9. O’Garra A, Redford PS, McNab FW, Bloom CI, Wilkinson RJ, Berry MP. The immune response in tuberculosis. AnnuRev Immunol 2013; 31: 475–527.
- 10. Gürkan F, Karabel M. Akciger tüberkülozunda klinik özellikler. In: Özçelik U, Kocabaş E, Ersu R, Gürkan F, ed. Çocukluk Çağında Tüberküloz. Istanbul: Toraks Kitapları; 2017: 13–16. (In Turkish).
- 11. Al Marri MR. The tuberculin skin test in confirmed pulmonary tuberculosis in the state of Qatar: where we stand? Qatar Med J 2013; 2012(2): 16–19.
- 12. Carvalho ACC, Cardoso CAA, Martire TM, Migliori GB, Sant’Anna CC. Epidemiological aspects, clinical manifestations, and prevention of pediatric tuberculosis from the perspective of the End TB Strategy. J Bras Pneumol 2018; 44(2): 134–144.
- 13. Lindenau JD, Salzano FM, Hurtado AM, Hill KR, Hutz MH. The role of variants from the innate immune system genes in tuberculosis and skin test response in a Native American population. Human Immunology 2016; 77(10): 981–984.
- 14. Shingadia D, Novelli V. Diagnosis and treatment of tuberculosis in children. Lancet Infect Dis 2003; 3(10): 624–632.
- 15. Aye S, Majumdar SS, Oo MM, Tripathy JP, Satyanarayana S, Kyaw NTT, et al. Evaluation of a tuberculosis active case finding project in peri-urban areas, Myanmar: 2014–2016. Int J Infect Dis 2018; 70: 93–100.
- 16. Saunders MJ, Wingfield T, Tovar MA, Baldwin MR, Datta S, Zevallos K, et al. A score to predict and stratify risk of tuberculosis in adult contacts of tuberculosis index cases: a prospective derivation and external validation cohort study.Lancet Infect Dis 2017; 17(11): 1190–1199.
- 17. Ogbudebe CL, Adepoju V, Ekerete-Udofia C, Abu E, Egesemba G, Chukwueme N, et al. Childhood tuberculosis in Nigeria: disease presentation and treatment outcomes. Health Serv Insights 2018; 11: 1–7.
- 18. Sakhno LV, Tikhonova MA, Tyrinova TV, Leplina OY, Shevela EY, Nikonov SD, et al. Cytotoxic activity of dendritic cells as a possible mechanism of negative regulation of T lymphocytes in pulmonary tuberculosis. Clin Dev Immunol 2012; 2012: 628635.
- 19. Cruz AT, Starke JR. Clinical manifestations of TB in children. Paediatr Respir Rev 2007; 8(2): 107–117.
- 20. Thomas TA. Tuberculosis in Children. Pediatr Clin N Am 2017; 64(4): 893–909.
- 21. Ning-ning T, Yi-fan L, Yun-xia L, Jin-yue L, Wan-mei S, Yao L, et al. Epidemiological characteristics of pulmonary tuberculosis among children in Shandong, China, 2005–2017. BMC Infect Dis 2019; 19: 408.
- 22. Ziemele B, Ranka R, Ozere I. Pediatric and adolescent tuberculosis in Latvia, 2011–2014: case detection, diagnosis and treatment. Int J Tuberc Lung Dis 2017; 21(6): 637–645.